<!DOCTYPE html>
<html lang="en">
<head>
    <meta charset="UTF-8">
    <meta name="viewport" content="width=device-width,initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no" />
    <script src="/statics/js/flexible.js"></script>
    <title>医院管理</title>
    <link rel="stylesheet" href="/statics/css/bootstrap.min.css">
    <link rel="stylesheet" href="/statics/css/common.css">
    <link rel="stylesheet" href="/statics/css/complain_patient.css">
</head>
<body>
<div class="container-fluid container-fluid-padding text-center">院内投诉</div>
<!--患者基本信息  开始-->
<div class="container-fluid container-fluid-margin-top define-active">
    <div class="row define-list-nav define-border-bottom">
        <div class="col-xs-6"><img style="width: 0.3rem;" src="/statics/images/conplain_patienter.png" alt=""><span>投诉人</span></div>
        <div class="col-xs-6 text-right"><img class="define-drawer-animation" src="/statics/images/conplain_down.png" alt=""></div>
    </div>
    <div class="define-list">
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">姓名</div>
            <div class="col-xs-6 text-right">
                <!--铜人宝-->
                <input style="border: none;outline: none;" id="complain_name" class="define-placeholder text-right" type="text" value="" placeholder="请输入姓名">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">性别</div>
            <div class="col-xs-6 text-right" id="picker-sex"><span>男</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">年龄</div>
            <div class="col-xs-6 text-right">
                <!--25-->
                <input style="border: none;outline: none;" id="complain_age" class="define-placeholder text-right" type="number" value="" placeholder="请输入年龄">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">手机号</div>
            <div class="col-xs-6 text-right"><!--13556565656-->
                <input style="border: none;outline: none;" id="complain_phone" class="define-placeholder text-right" type="number" value="" placeholder="请输入手机号">
            </div>
        </div>
        <div class="row define-list-item">
            <div class="col-xs-6">微信号</div>
            <div class="col-xs-6 text-right"><!--昵称。-->
                <input style="border: none;outline: none;" id="complain_wechat" class="define-placeholder text-right" type="text" value="" placeholder="请输入昵称">
            </div>
        </div>
    </div>
</div>
<!--患者基本信息  结束-->
<!--投诉信息  开始-->
<div class="container-fluid container-fluid-margin-top">
    <div class="row define-list-nav define-border-bottom">
        <div class="col-xs-6"><img style="width: 0.453333rem;" src="/statics/images/conplain_info.png" alt=""><span>投诉信息</span></div>
        <div class="col-xs-6 text-right"><img class="define-drawer-animation define-close-active" src="/statics/images/conplain_down.png" alt=""></div>
    </div>
    <div class="define-list">
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">被投诉人</div>
            <div class="col-xs-6 text-right"><!--铜仁宝-->
                <input style="border: none;outline: none;" id="complain_by_name" class="define-placeholder text-right" type="text" value="" placeholder="请输入被投诉人">
            </div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">被投诉人所在科室</div>
            <div class="col-xs-6 text-right" id="picker-complain-department"><span>请选择</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-6">投诉类型</div>
            <div class="col-xs-6 text-right" id="picker-complain-status"><span>选择投诉类型</span><img class="define-right" src="/statics/images/conplain_right.png" alt=""></div>
        </div>
        <div class="row define-list-item define-border-bottom">
            <div class="col-xs-4">投诉内容</div>
            <div class="col-xs-8 text-right"><!--投诉内容投诉内容-->
                <input style="border: none;outline: none;"id="complain_by_content" class="define-placeholder text-right" type="text" value="" placeholder="请输入投诉内容">
            </div>
        </div>
        <div class="row define-list-item">
            <div class="col-xs-4">图片上传</div>
            <div class="col-xs-8 text-right">
                <img class="define-add-img" id="complain_by_imgurl_one" src="/statics/images/conplain_add.png" alt="">
                <form name="define_add_img_1_form" id="define_add_img_1_form" style="display: none;">
                    <input type="file" id="define-add-img-1">
                </form>
                <img class="define-add-img" id="complain_by_imgurl_two" src="/statics/images/conplain_add.png" alt="">
                <form name="define_add_img_2_form" id="define_add_img_2_form" style="display: none;">
                    <input type="file" id="define-add-img-2">
                </form>
                <img class="define-add-img" id="complain_by_imgurl_three" src="/statics/images/conplain_add.png" alt="">
                <form name="define_add_img_3_form" id="define_add_img_3_form" style="display: none;">
                    <input type="file" id="define-add-img-3">
                </form>
            </div>
        </div>
    </div>
</div>
<!--投诉信息  结束-->
<!--提交  开始-->
<div class="container-fluid container-fluid-margin-top text-center" id="post">
    提交
</div>
<!--提交  结束-->
<div class="define-mark" id="define-mark"></div>

<!--模态框  开始-->
<div class="modal fade bs-example-modal-lg" id="myLargeModalLabel" tabindex="-1" role="dialog" aria-labelledby="myLargeModalLabel">
    <div class="modal-dialog modal-lg" role="document">
        <div class="modal-content text-center">
            表单提交成功!
        </div>
    </div>
</div>
<!--模态框  结束-->

<!--form表单  开始-->
<form action="/complain/hospital" method="post" id="post_form" style="display: none;">
    <!--性别  男：1 女：0-->
    <!--投诉人-->
    <input type="text" name="hos_people_name" value="">
    <input type="text" name="hos_people_sex" value="1">
    <input type="text" name="hos_people_age" value="">
    <input type="text" name="hos_people_phone" value="">
    <input type="text" name="hos_people_wx" value="">
    <!--投诉信息-->
    <input type="text" name="hos_by_people_name" value="">
    <input type="text" name="hos_by_people_admin" value="">
    <input type="text" name="hos_by_people_status" value="">
    <input type="text" name="hos_by_people_content" value="">
    <input type="text" name="hos_by_people_imgurl" value="">
</form>
<!--form表单  结束-->
<script type="text/javascript" src="/statics/js/jquery-3.1.1.min.js"></script>
<script type="text/javascript" src="/statics/js/bootstrap.min.js"></script>
<script type="text/javascript" src="/statics/js/mui.min.js"></script>
<script type="text/javascript" src="/statics/js/mui.picker.js"></script>
<script type="text/javascript" src="/statics/js/mui.poppicker.js"></script>
<script type="text/javascript" src="/statics/js/complain_hospital.js"></script>
</body>
</html>